Breastfeeding: I am not a NAZI!!

My aunt Peg once said about my blog: "You think everyone is entitled to your opinion". If not here, then where? Up on my high horse I mount...So, as some of you know, the other night at work we were discussing breastfeeding and I (once again?) was defending patients who choose to exclusively breastfeed and decline supplements. Why? Sure my job would be WAY easier to just tell these weepy, sleep deprived parents that "one bottle won't hurt". I mean, the baby would assuredly fall asleep. Mom would "finally" get some sleep and dad could pass (all the way) out. BUT, I can't bring myself to do it. After all of the time I have spent being trained by some of the field's most respected professionals (Shout out to Gini Baker and the esteemed Dr. Nancy Wight), reviewed countless hours of literature as part of my CLE coursework, my RN internship and in preparation for teaching classes on breastfeeding management to my peers, it just feels wrong. I know better. I want to Keep Austin (and the world) Breastfeeding.

I was taught that infant formula's only place in a hospital is as a medication. The risks of feeding formula outweigh the benefits in most cases. Dehydration is the most common ailment that would indicate formula supplementation, and I do recommend formula to babies who are clinically dehydrated, but I don't use weight loss percentage as a defining tool. The whole picture has to be assessed. In my career, I have probably only encountered a handful of infants who were clinically dehydrated. I also fully support a mother's choice NOT to supplement her term jaundiced baby who is receiving phototherapy but breastfeeding well. Why? Because the literature doesn't support blanket formula supplementation. Sure the baby's bili levels would drop quicker (research says about 10 hours faster) but what is the message? "Breastfeeding made your baby sick. Now, it has to be fixed with formula." Our goal should be best practice not quickest treatment and therefore sooner discharge. We know that 99.9% of the time, barring major pathological issues (which, coincidentally aren't going to respond to formula treatment) phototherapy will work and that even without phototherapy most jaundice is self-limiting. So basically 3 days of jaundice vs 12 months of breastfeeding...hmmm? Further, there is a ton of research that indicates that increased bilirubin levels may be beneficial to neonates. The Academy of Breastfeeding Medicine's protocol for supplementing term babies in the hospital can be found here. Click on supplementation.

I chose this profession over all others and, as cheesy and idealistic as it my sound, I want to do right by my patients, every.single.time. I want to help every single baby get the very best nutrition. I want to help meet our nation's Healthy People 2010 Goals for breastfeeding. I practice as if my hospital were Baby Friendly.

But this is not to say that I am a "Breastfeeding Nazi". And really, I resent that term on several levels. My position is this: I believe that women have the right to choose to use their breasts for feeding their babies OR NOT. If one of my patients says "I want to feed my baby with formula" I do not try to talk her into breastfeeding or shame her or tell her the 101 reasons breastfeeding is better. However, when a "breastfeeding only" patient calls me into her room because her baby is crying and wants to eat "all night long", I tell her that her baby is perfect and doing just what babies do on their second night of life AND explain all of the reasons (weight loss, hydration status, bili level) that her baby DOES NOT NEED formula. Of course, if she still wants it, I gladly give it. I am just not going to RECOMMEND formula if it is not indicated. When a patient tells me that she only wants to breastfeed, I support that decision with every fiber of my being. I have and will hold a baby at it's mother's breast for an entire feeding if need be. Remember, I am the mother's AND the baby's nurse. I need to advocate for the baby, too :) I prefer the term "Breastfeeding Advocate". It helps me sleep at night knowing that those babies just might make it to 3 months, 6 months or even a year without drinking formula. I don't judge people for not breastfeeding but I do wish that everyone would at least try. I think that all babies deserve breastmilk but I also understand that there are multiple factors that can impair the establishment of a healthy breastfeeding relationship. I'm just not willing to be one of them.


***And lastly, if my baby can make it out of the NICU after a week without being supplemented because I dragged my freshly cut open body down the hall every 3 hours, you pansy-ass postpartum princesses can suck it up and let your babies cluster feed for one night****

References for the nerds:

Academy of Breastfeeding Medicine ABM Protocol Number 3-Hospital Guidelines for the Use of Supplementary Feedings in the Healthy Term Breastfed Neonate

Berens, P.D. MD (2004) Applied physiology in the peripartum management of lactation Clinical Obstetrics and Gynecology, 47 (3) 643-655

Dewey, K., & Nommse-Rivers, L. (2004) Risk factors for suboptimal infant breastfeeding behavior, delayed onset of lactation and excess neonatal weight loss Obstetrical and Gynecological Survey 59 (3) 179-181

Gordon, J. MD Bilirubin as an antioxidant

Holcomb, S. (2005) Managing jaundice in full term infants American Journal of Primary Health Care 30(1) 6-12

Johnson, L. MD & Bhutani, V. MD (2002)System based approach to management of neonatal jaundice and preventioin of kernicterus The Journal of Pediatrics 140 (4) 396-403

Neifert, M. MD (2004) Breastmilk transfer: positioning, latch-on and screening for problems in milk transfer Clinical Obstetrics and Gynegology 47 (3) 656-675

Newton, E. MD (2004) The epidemiology of breastfeeding Clinical Obstetrics and Gynecology 47 (3) 613-623

Ostrow, J. & Tiribelli, C. (2003) Bilirubin, a curse and a boon Gut 52 (12) 1667-1670

Shoemaker, M. MD & Ellis, M. MD (2003) Should jaundiced infants be breastfed? The journal of Family Practice 52 (11) 895-896

Tan, K. (1999) Decreased response to phototherapy for neonatal jaundice in breastfed infants Obstetrical and Gynecological Survey 54 (7) 436-437

Willis, S. DrPH & Hannon, P. MD (2002) The impact of maternal experience with a jaundiced newborn on the breastfeeding relationship The Journal of Family Practice 51(5) 465